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Gingrich AA, Flojo RB, Walsh A, Olson J, Hanson D, Bateni SB, Gholami S, Kirane AR. Are Palliative Interventions Worth the Risk in Advanced Gastric Cancer? A Systematic Review. J Clin Med 2024; 13:5809. [PMID: 39407868 PMCID: PMC11478195 DOI: 10.3390/jcm13195809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Revised: 09/17/2024] [Accepted: 09/19/2024] [Indexed: 10/20/2024] Open
Abstract
Background: Less than 25% of gastric cancers (GC) are discovered early, leading to limited treatment options and poor outcomes (27.8% mortality, 3.7% 5-year survival). Screening programs have improved cure rates, yet post-diagnosis treatment guidelines remain unclear (systemic chemotherapy versus surgery). The optimal type of palliative surgery (palliative gastrectomy (PG), surgical bypass (SB), endoscopic stenting (ES)) for long-term outcomes is also debated. Methods: A literature review was conducted using PubMed, MEDLINE, and EMBASE databases along with Google Scholar with the search terms "gastric cancer" and "palliative surgery" for studies post-1985. From the initial 1018 articles, multiple screenings narrowed it to 92 articles meeting criteria such as "metastatic, stage IV GC", and intervention (surgery or chemotherapy). Data regarding survival and other long-term outcomes were recorded. Results: Overall, there was significant variation between studies but there were similarities of the conclusions reached. ES provided quick symptom relief, while PG showed improved overall survival (OS) only with adjuvant chemotherapy in a selective population. PG had higher mortality rates compared to SB, with ES having a reported 0% mortality, but OS improved with chemotherapy across both SB and PG. Conclusions: Less frail patients may experience an improvement in OS with palliative resection under limited circumstances. However, operative intervention without systemic chemotherapy is unlikely to demonstrate a survival benefit. Further research is needed to explore any correlations.
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Affiliation(s)
- Alicia A. Gingrich
- Department of Surgery, MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Renceh B. Flojo
- Department of Surgery, Section of Surgical Oncology, Stanford University, 1201 Welch Road MSLS 214, Palo Alto, CA 94305, USA;
| | - Allyson Walsh
- Department of Surgery, UC Davis, Sacramento, CA 95817, USA; (A.W.); (D.H.)
| | | | - Danielle Hanson
- Department of Surgery, UC Davis, Sacramento, CA 95817, USA; (A.W.); (D.H.)
| | - Sarah B. Bateni
- Department of Surgery, Northwell Health, New Hyde Park, NY 11040, USA;
| | - Sepideh Gholami
- Department of Surgery, University of Alabama Birmingham, Birmingham, AL 35294, USA;
| | - Amanda R. Kirane
- Department of Surgery, Section of Surgical Oncology, Stanford University, 1201 Welch Road MSLS 214, Palo Alto, CA 94305, USA;
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2
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Yang Z, Lu S, Shi M, Yuan H, Wang Z, Ni Z, He C, Zheng Y, Zhu Z, Liu W, Yao X, Zhang J, Li C, Yan M, Yan C, Zhu Z. Oncological outcomes of conversion therapy in gastric cancer patients with peritoneal metastasis: a large-scale retrospective cohort study. Gastric Cancer 2024; 27:387-399. [PMID: 38143257 PMCID: PMC10896904 DOI: 10.1007/s10120-023-01452-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/19/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Data on the long-term oncological outcomes of patients who undergo conversion surgery (CS) in gastric cancer (GC) patients with peritoneal metastasis (PM) are limited. METHODS GC patients with PM who received intraperitoneal (ip) and systemic chemotherapy between April 2015 and January 2021 were enrolled. Multivariate analysis was performed to identify risk factors associated with survival. Clinicopathological and survival outcomes were compared between those with CS and those without CS (NCS). The paclitaxel (PTX) plus tegafur-gimeracil-oteracil potassium capsules (S-1) (PS) + ip PTX and oxaliplatin plus S-1 (SOX) + ip PTX groups were matched in a 1:1 ratio using propensity score matching. Oncological and survival data were collected and analyzed. RESULTS A total of 540 patients who received ip chemotherapy via subcutaneous port and systemic chemotherapy were analyzed and 268 patients were enrolled, including 113 who underwent CS and 155 who did not. Overall survival (OS) were 27.0 months and 11.8 months in the CS and NCS groups (P < 0.0001), respectively. R0 resection was an independent prognostic factor for patients who underwent CS. The OS of patients with or without ovariectomy was 21.3 or 12.0 months (P < 0.0001). No difference of clinicopathological and survival outcomes was found between the PS + ip PTX and SOX + ip PTX groups. CONCLUSION Conversion therapy is safe and adverse events were manageable. CS improves the survival of GC patients with PM after ip and systemic chemotherapy. R0 is an important prognostic factor. Furthermore, outcomes are comparable between the PS + ip PTX and SOX + ip PTX groups.
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Affiliation(s)
- Zhongyin Yang
- Shanghai Key Laboratory of Gastric Neoplasms, Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, China
| | - Sheng Lu
- Shanghai Key Laboratory of Gastric Neoplasms, Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, China
| | - Min Shi
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Yuan
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenqiang Wang
- Shanghai Key Laboratory of Gastric Neoplasms, Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, China
| | - Zhentian Ni
- Shanghai Key Laboratory of Gastric Neoplasms, Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, China
| | - Changyu He
- Shanghai Key Laboratory of Gastric Neoplasms, Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, China
| | - Yanan Zheng
- Shanghai Key Laboratory of Gastric Neoplasms, Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, China
| | - Zhenglun Zhu
- Shanghai Key Laboratory of Gastric Neoplasms, Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, China
| | - Wentao Liu
- Shanghai Key Laboratory of Gastric Neoplasms, Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, China
| | - Xuexin Yao
- Shanghai Key Laboratory of Gastric Neoplasms, Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, China
| | - Jun Zhang
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Li
- Shanghai Key Laboratory of Gastric Neoplasms, Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, China
| | - Min Yan
- Shanghai Key Laboratory of Gastric Neoplasms, Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, China
| | - Chao Yan
- Shanghai Key Laboratory of Gastric Neoplasms, Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, China.
| | - Zhenggang Zhu
- Shanghai Key Laboratory of Gastric Neoplasms, Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, China
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Tham E, Sestito M, Markovich B, Garland-Kledzik M. Current and future imaging modalities in gastric cancer. J Surg Oncol 2022; 125:1123-1134. [PMID: 35481912 DOI: 10.1002/jso.26875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 12/24/2022]
Abstract
Gastric adenocarcinoma treatment can include endoscopic mucosal resection, surgery, chemotherapy, radiation, and palliative measures depending on staging. Both invasive and noninvasive staging techniques have been used to dictate the best treatment pathway. Here, we review the current imaging modalities used in gastric cancer as well as novel techniques to accurately stage and screen these patients.
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Affiliation(s)
- Elwin Tham
- Department of Surgical Oncology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Michael Sestito
- Department of Surgical Oncology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Brian Markovich
- Department of Diagnostic Radiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Mary Garland-Kledzik
- Department of Surgical Oncology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
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Kroese TE, van Laarhoven HWM, Nilsson M, Lordick F, Guckenberger M, Ruurda JP, D'Ugo D, Haustermans K, van Cutsem E, van Hillegersberg R, van Rossum PSN. Definition of oligometastatic esophagogastric cancer and impact of local oligometastasis-directed treatment: A systematic review and meta-analysis. Eur J Cancer 2022; 166:254-269. [PMID: 35339868 DOI: 10.1016/j.ejca.2022.02.018] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/11/2022] [Accepted: 02/19/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Local treatment (metastasectomy or stereotactic radiotherapy) for oligometastatic disease (OMD) in patients with esophagogastric cancer may improve overall survival (OS). The primary aim was to identify definitions of esophagogastric OMD. A secondary aim was to perform a meta-analysis of OS after local treatment versus systemic therapy alone for OMD. METHODS Studies and study protocols reporting on definitions or OS after local treatment for esophagogastric OMD were included. The primary outcome was the maximum number of organs/lesions considered OMD and the maximum number of lesions per organ (i.e. 'organ-specific' OMD burden). Agreement was considered to be either absent/poor (< 50%), fair (50%-75%), or consensus (≥ 75%). The secondary outcome was the pooled adjusted hazard ratio (aHR) for OS after local treatment versus systemic therapy alone. The ROBINS tool was used for quality assessment. RESULTS A total of 97 studies, including 7 study protocols, and 2 prospective studies, were included. OMD was considered in 1 organ with ≤ 3 metastases (consensus). 'Organ-specific' OMD burden could involve bilobar ≤ 3 liver metastases, unilateral ≤ 2 lung metastases, 1 extra-regional lymph node station, ≤ 2 brain metastases, or bilateral adrenal gland metastases (consensus). Local treatment for OMD was associated with improved OS compared with systemic therapy alone based on 6 non-randomized studies (pooled aHR 0.47, 95% CI: 0.30-0.74) and for liver oligometastases based on 5 non-randomized studies (pooled aHR 0.39, 95% CI: 0.22-0.59). All studies scored serious risk of bias. CONCLUSIONS Current literature considers esophagogastric cancer spread limited to 1 organ with ≤ 3 metastases or 1 extra-regional lymph node station to be OMD. Local treatment for OMD appeared associated with improved OS compared with systemic therapy alone. Prospective randomized trials are warranted.
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Affiliation(s)
- Tiuri E Kroese
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Magnus Nilsson
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Florian Lordick
- Department of Oncology, University Cancer Center Leipzig (UCCL), Leipzig University Medical Center, Leipzig, Germany
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zürich, University of Zurich, Zürich, Switzerland
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Domenico D'Ugo
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | | | | | - Richard van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Peter S N van Rossum
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Sun M, Ding H, Zhu Z, Wang S, Gu X, Xia L, Li T. Identifying Optimal Surgical Intervention-Based Chemotherapy for Gastric Cancer Patients With Liver Metastases. Front Oncol 2021; 11:675870. [PMID: 34912701 PMCID: PMC8666972 DOI: 10.3389/fonc.2021.675870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 11/08/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND This study aimed at evaluating the effects of surgical treatments-based chemotherapy in the treatment of gastric cancer with liver metastases (GCLM). It has not been established whether Liver-directed treatment (LDT) options such as hepatectomy and gastrectomy plus chemotherapy (HGCT), radiofrequency ablation and gastrectomy plus chemotherapy (RFAG), transarterial chemoembolization and gastrectomy plus chemotherapy (TACEG), gastrectomy plus chemotherapy (GCT) enhance the survival of GCLM patients. METHODS We performed systematic literature searches in PubMed, EMBASE, and Cochrane library from inception to September 2021. We created a network plot to comprehensively analyze the direct and indirect evidence, based on a frequentist method. A contribution plot was used to determine inconsistencies, a forest plot was used to evaluate therapeutic effects, the publication bias was controlled by funnel plot, while the value of surface under the cumulative ranking curves (SUCRA) was calculated to estimate rank probability. RESULTS A total of 23 retrospective studies were identified, involving 5472 GCLM patients. For OS and 1-, 2-, 3-year survival rate of all trials, meta-analysis of the direct comparisons showed significant better for HGCT treatments compared with GCT or PCT. In the comparison of the 5 treatments for 1-, 2-, 3-year survival rate, HGCT and RFAG were found to be more effective than GCT and PCT, respectively. By OS and 2-, 3-year survival rate analysis, RFAG was identified as the best option, followed by HGCT, TACEG, GCT and PCT. By 1-year survival rate analysis, HGCT and RFAG were identified as the most effective options. CONCLUSION HGCT and RFAG has remarkable survival benefits for GCLM patients when compared to TACEG, GCT and PCT. HGCT was found to exhibit superior therapeutic effects for GCLM patients for 1-year survival rate while RFAG was found to be a prospective therapeutic alternative for OS and 2-, 3-year survival rate. SYSTEMATIC REVIEW REGISTRATION identifier [10.37766/inplasy2020.12.0009].
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Affiliation(s)
- Min Sun
- Department of General Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
- Department of Anesthesiology, Institute of Anesthesiology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
- Hubei Key Laboratory of Embryonic Stem Cell Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Hangliang Ding
- Department of General Surgery, Xinchang Hospital Affiliated to Wenzhou Medical University, Wenzhou, China
| | - Zhiqiang Zhu
- Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shengsheng Wang
- Department of General Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Xinsheng Gu
- College of Basic Medical Sciences, Hubei University of Medicine, Shiyan, China
| | - Lingyun Xia
- Department of Stomatology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Tian Li
- Department of General Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
- School of Basic Medicine, Fourth Military Medical University, Xi’an, China
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Di Virgilio F, Belluzzi E, Santos M, Caraty J, Bongartz A, Deneuche A. Practice patterns about the role of palliation in veterinary surgical oncology. Vet Comp Oncol 2021; 19:750-758. [PMID: 34260820 DOI: 10.1111/vco.12754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 06/29/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
Whether surgical palliative therapy is appropriate for oncologic veterinary patients is an increasing concern as pet age increases because of improved care. In this study, an online survey (available for 30 days), comprising 100 questions with structured response options, was administered to 492 diplomates of the European College of Veterinary Surgeons (ECVS). The survey queried the technical, ethical, social, medical, and financial aspects of surgical palliative therapy for oncologic veterinary patients. Responses were received from 155 ECVS diplomates (31.5%, n = 155/492). Palliative surgery was a relatively common intervention in veterinary oncology, with 50% of respondents (n = 77.5/155) indicating that 75%-100% of oncological surgeries performed were palliative. The presence of metastasis was judged as a key determinant when deciding to perform palliative oncological surgery by 41% of the respondents (n = 63.5/155). The survey revealed that the most commonly performed procedures in palliative oncological surgery were marginal resection, debulking, and amputation. In contrast to human medicine, palliative limb-sparing surgery, stent placement, and embolization were rarely used in veterinary settings, mainly because of a general lack of expertise among veterinarians, elevated costs, and recourse to euthanasia. Taken together, the survey results highlight the need for appropriate guidelines in the field of oncological surgery. To establish general guidelines and direct veterinarians towards the most appropriate judgement, understanding how and what veterinary surgeons manage palliative oncological surgery and how they perceive the main ethical, social, medical, and financial concerns are essential. Such guidelines will lead to better care for ailing animals and will facilitate the path to healing for owners.
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Affiliation(s)
| | - Elena Belluzzi
- Department of Surgery, Clinique Vétérinaire Bongartz, Liège, Belgium
| | - Marisa Santos
- Department of Surgery, Clinique Vétérinaire Vet24, Marcq en Baroeul, France
| | - Johan Caraty
- Department of Surgery, Clinique Vétérinaire Bongartz, Liège, Belgium
| | | | - Aymeric Deneuche
- Department of Surgery, Clinique Vétérinaire Vet24, Marcq en Baroeul, France
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Berger Y, Giurcanu M, Vining CC, Schuitevoerder D, Posner MC, Roggin KK, Polite BN, Liao CY, Eng OS, Catenacci DVT, Turaga KK. Cytoreductive Surgery for Selected Patients Whose Metastatic Gastric Cancer was Treated with Systemic Chemotherapy. Ann Surg Oncol 2021; 28:4433-4443. [PMID: 33420565 DOI: 10.1245/s10434-020-09475-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 12/01/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The authors hypothesized that cytoreductive surgery (CRS, comprising gastrectomy combined with metastasectomy) in addition to systemic chemotherapy (SC) is associated with a better survival than chemotherapy alone for patients with metastatic gastric adenocarcinoma (MGA). METHODS Patients with MGA who received SC between 2004 and 2016 were identified using the National Cancer Database (NCDB). Nearest-neighbor 1:1 propensity score-matching was used to create comparable groups. Overall survival (OS) was compared between subgroups using Kaplan-Meier analyses. Immortal bias analysis was performed among those who survived longer than 90 days. RESULTS The study identified 29,728 chemotherapy-treated patients, who were divided into the following four subgroups: no surgery (NS, n = 25,690), metastasectomy alone (n = 1170), gastrectomy alone (n = 2248), and CRS (n = 620) with median OS periods of 8.6, 10.9, 14.8, and 16.3 months, respectively (p < 0.001). Compared with the patients who underwent NS, the patients who had CRS were younger (58.9 ± 13.4 vs 62.0 ± 13.1 years), had a lower proportion of disease involving multiple sites (4.6% vs 19.1%), and were more likely to be clinically occult (cM0 stage: 59.2% vs 8.3%) (p < 0.001 for all). The median OS for the propensity-matched patients who underwent CRS (n = 615) was longer than for those with NS (16.4 vs 9.3 months; p < 0.001), including in those with clinical M1 stage (n = 210). In the Cox regression model using the matched data, the hazard ratio for CRS versus NS was 0.56 (95% confidence interval [CI], 0.49-0.63). In the immortal-matched cohort, the corresponding median OS was 17.0 versus 9.5 months (p < 0.001). CONCLUSIONS In addition to SC, CRS may be associated with an OS benefit for a selected group of MGA patients meriting further prospective investigation.
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Affiliation(s)
- Yaniv Berger
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Mihai Giurcanu
- Department of Public Health Sciences, University of Chicago Medical Center, Chicago, IL, USA
| | - Charles C Vining
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | | | - Mitchell C Posner
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Kevin K Roggin
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Blase N Polite
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Chih-Yi Liao
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Oliver S Eng
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | | | - Kiran K Turaga
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA.
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Jiang D, Xu Y, Chen Y, Jiang J, Wang M, Yang M, Chen Z, Yang L. Apatinib Combined With SOX Regimen in Conversion Treatment of Advanced Gastric Cancer: A Case Series and Literature Review. Front Pharmacol 2020; 11:1027. [PMID: 32765260 PMCID: PMC7381218 DOI: 10.3389/fphar.2020.01027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 06/24/2020] [Indexed: 12/30/2022] Open
Abstract
Gastric cancer is a common digestive tract tumor and the second most prevalent cancer. The prognosis of advanced gastric cancer is poor. Conversion therapy can reduce tumor burden, downgrade tumor, and increase the possibility of complete resection, thus prolonging the survival time of patients with gastric cancer. In conversion therapy, chemotherapy and targeted therapy are the main methods of medical treatment, which can control tumor growth and recurrence. As an antiangiogenic targeted drug, apatinib is widely used in the third-line treatment of advanced gastric cancer. Recent studies have shown that it may be of great help in rapid reduction of tumor stage and improvement of prognosis in conversion therapy. This study reported three cases of gastric cancer complicated with multiple abdominal and retroperitoneal lymph node metastases. After receiving apatinib combined with SOX regimen for four cycles, computed tomography showed that the focus and lymph node metastasis were reduced after treatment, and primary tumors were resected. Postoperative pathology result showed that the patients got R0 resection. After radical surgery, the maintenance therapy including apatinib was given. The progression-free survival time was more than 10 months. Apatinib combined with SOX regimen as a conversion therapy for advanced gastric adenocarcinoma increases the possibility of successful surgical resection, which might prolong the survival time of patients.
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Affiliation(s)
- Dingyi Jiang
- Department of Medical Oncology, The Qingdao University Medical College, Qingdao, China
| | - Yunyun Xu
- Department of Medical Oncology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Yunwang Chen
- Department of Medical Oncology, The Qingdao University Medical College, Qingdao, China
| | - Jiahong Jiang
- Department of Medical Oncology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Mingxing Wang
- Department of Medical Oncology, Bengbu Medical College, Bengbu, China
| | - Min Yang
- Department of Medical Oncology, The Qingdao University Medical College, Qingdao, China
| | - Zheling Chen
- Department of Medical Oncology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Liu Yang
- Department of Medical Oncology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
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Abstract
OBJECTIVE. The purpose of this case-based article is to discuss the pathophysiologic findings, common pathways of spread, and imaging features associated with Krukenberg tumors. CONCLUSION. Not all ovarian metastases are Krukenberg tumors. Krukenberg tumors are the most common subtype of ovarian metastases, and they are histologically characterized by signet ring cell mucinous features. Common primary tumor sites include the stomach or colon. Although often difficult, distinguishing between Krukenberg tumors and primary ovarian malignancy on imaging is important because of management and prognostic implications.
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10
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Renzulli M, Clemente A, Spinelli D, Ierardi AM, Marasco G, Farina D, Brocchi S, Ravaioli M, Pettinari I, Cescon M, Reginelli A, Cappabianca S, Carrafiello G, Golfieri R. Gastric Cancer Staging: Is It Time for Magnetic Resonance Imaging? Cancers (Basel) 2020; 12:1402. [PMID: 32485933 PMCID: PMC7352169 DOI: 10.3390/cancers12061402] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/17/2020] [Accepted: 05/28/2020] [Indexed: 12/13/2022] Open
Abstract
Gastric cancer (GC) is a common cancer worldwide. Its incidence and mortality vary depending on geographic area, with the highest rates in Asian countries, particularly in China, Japan, and South Korea. Accurate imaging staging has become crucial for the application of various treatment strategies, especially for curative treatments in early stages. Unfortunately, most GCs are still diagnosed at an advanced stage, with the peritoneum (61-80%), distant lymph nodes (44-50%), and liver (26-38%) as the most common metastatic locations. Metastatic disease is limited to the peritoneum in 58% of cases; in nonperitoneal distant metastases, the most involved GC metastasization site is the liver (82%). The eighth edition of the tumor-node-metastasis staging system is the most commonly used system for determining GC prognosis. Endoscopic ultrasonography, computed tomography, and 18-fluorideoxyglucose positron emission tomography are historically the most accurate imaging techniques for GC staging. However, studies have recently shown renewed interest in magnetic resonance imaging (MRI) as a useful tool in GC staging, especially for distant metastasis assessment. The technical improvement of diffusion-weighted imaging and the increasing use of hepatobiliary contrast agents have been shown to increase the diagnostic performance of MRI, particularly for detecting peritoneal and liver metastasis. However, no principal oncological guidelines have included the use of MRI as a first-line technique for distant metastasis evaluation during the GC staging process, such as the National Comprehensive Cancer Network Guidelines. This review analyzed the role of the principal imaging techniques in GC diagnosis and staging, focusing on the potential role of MRI, especially for assessing peritoneal and liver metastases.
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Affiliation(s)
- Matteo Renzulli
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant’Orsola Hospital, University of Bologna, 40138 Bologna, Italy; (D.S.); (S.B.); (I.P.); (R.G.)
| | - Alfredo Clemente
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.C.); (A.R.); (S.C.)
| | - Daniele Spinelli
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant’Orsola Hospital, University of Bologna, 40138 Bologna, Italy; (D.S.); (S.B.); (I.P.); (R.G.)
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milan, Italy; (A.M.I.); (G.C.)
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy;
| | - Davide Farina
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, 25138 Brescia, Italy;
| | - Stefano Brocchi
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant’Orsola Hospital, University of Bologna, 40138 Bologna, Italy; (D.S.); (S.B.); (I.P.); (R.G.)
| | - Matteo Ravaioli
- General and Transplant Surgery Unit, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (M.R.); (M.C.)
| | - Irene Pettinari
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant’Orsola Hospital, University of Bologna, 40138 Bologna, Italy; (D.S.); (S.B.); (I.P.); (R.G.)
| | - Matteo Cescon
- General and Transplant Surgery Unit, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (M.R.); (M.C.)
| | - Alfonso Reginelli
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.C.); (A.R.); (S.C.)
| | - Salvatore Cappabianca
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.C.); (A.R.); (S.C.)
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milan, Italy; (A.M.I.); (G.C.)
| | - Rita Golfieri
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant’Orsola Hospital, University of Bologna, 40138 Bologna, Italy; (D.S.); (S.B.); (I.P.); (R.G.)
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11
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Ge XY, Ge F, Wang Z, Wang YL, Lei LW, Liu QR, Sun XY, Jiang X. Analysis of risk factors of stage IV gastric cancer from the SEER database. Ann R Coll Surg Engl 2020; 102:355-362. [PMID: 32326735 PMCID: PMC7374772 DOI: 10.1308/rcsann.2020.0031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Gastric cancer is the fourth most common cancer in the world. By the time the patients are diagnosed with stage IV gastric cancer, many patients already have distant metastases. There is no unified systemic treatment plan in existence. The use of gastrectomy is ambiguous in patients with stage IV gastric cancer. The objective of this study was to evaluate the beneficial outcome of gastrectomy in patients with stage IV gastric cancer. METHODS Clinical information of patients with gastric cancer from 2000 to 2010 in the Surveillance, Epidemiology, and End Results database were extracted and analysed. The risk factors for stage IV gastric cancer were also analysed. RESULTS We observed that the median survival time for patients after surgery was greater than that for patients not treated surgically. The five-year survival rate for chemotherapy patients was higher than that of non-chemotherapeutic patients. Patients who receive both chemotherapy and surgery could achieve a more significant survival benefit. The risks following gastrectomy (partial, subtotal, hemi-) were lower than those of other surgical procedures, which provided guidance on the choice of surgical method. The numbers of regional lymph node metastasis were found to be related to prognosis. CONCLUSIONS In patients with stage IV gastric cancer, gastrectomy (partial, subtotal or hemi) should be selected when surgery is necessary. The number of regional lymph node metastasis could be considered as a prognostic factor for patients with stage IV gastric cancer and lymph node dissection could reduce the risk of patients undergoing surgery.
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Affiliation(s)
- X-Y Ge
- First Affiliated Hospital of Harbin Medical University, Harbin, PR China
| | - F Ge
- First Affiliated Hospital of Harbin Medical University, Harbin, PR China
| | - Z Wang
- Anshan Central Hospital, Anshan, PR China
| | - YL Wang
- First Affiliated Hospital of Harbin Medical University, Harbin, PR China
| | - LW Lei
- First Affiliated Hospital of Harbin Medical University, Harbin, PR China
| | - QR Liu
- First Affiliated Hospital of Harbin Medical University, Harbin, PR China
| | - XY Sun
- First Affiliated Hospital of Harbin Medical University, Harbin, PR China
| | - X Jiang
- First Affiliated Hospital of Harbin Medical University, Harbin, PR China
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12
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Liang C, Chen H, Yang Z, Han C, Ren C. Risk factors and prognosis of bone metastases in newly diagnosed gastric cancer. Future Oncol 2020; 16:733-748. [PMID: 32285687 DOI: 10.2217/fon-2019-0728] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aim: To predict the occurrence of bone metastases and prognosis among patients with gastric cancer on a population level. Materials & methods: Data were obtained from the SEER database (2010-2016). Multivariable logistic regression and multivariable Cox regression were used to determine factors that predict the occurrence of bone metastasis and prognosis. Results: Cardia cancer, younger age, white race, poor differentiation grade, higher N stage, diffuse-type were positively associated with the presence of bone metastasis. For gastric cancer patients with bone metastasis, the median survival time was longer (9.0 months) among patients with surgery of primary site compared with those without surgery (3.0 months). Conclusion: According to the results of risk assessment, clinical efforts should be targeted to focus on screening high-risk patients.
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Affiliation(s)
- Chengtong Liang
- Department of Laboratory Medicine, Dalian Medical University, Dalian, PR China
| | - Hui Chen
- Geriatric Medicine, Clinical Medical College of Yangzhou University, Yangzhou, PR China
| | - Zhanjun Yang
- School of Chemistry & Chemical Engineering, Yangzhou University, Yangzhou, PR China
| | - Chongxu Han
- Department of Laboratory Medicine, Clinical Medical College of Yangzhou University, Yangzhou, PR China
| | - Chuanli Ren
- Department of Laboratory Medicine, Clinical Medical College of Yangzhou University, Yangzhou, PR China.,Department of Laboratory Medicine, Yangzhou Clinical Medical College of Xuzhou Medical University, Yangzhou, PR China
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13
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Zhang K, Chen L. Chinese consensus on the diagnosis and treatment of gastric cancer with liver metastases. Ther Adv Med Oncol 2020; 12:1758835920904803. [PMID: 32127925 PMCID: PMC7036491 DOI: 10.1177/1758835920904803] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 01/14/2020] [Indexed: 01/27/2023] Open
Abstract
Background The incidence of gastric cancer with liver metastases (GCLM) is 9.9-18.7%, with a median survival time of 11 months and a 5-year survival rate <20%. Multidisciplinary treatment (MDT) is gradually gaining recognition as the most important method. However, specific treatment plans remain unclear. The aim of study was to provide a consensus to improve the diagnosis and treatment of GCLM. Methods We brought together experts from relevant medical fields across China, including the Chinese Research Hospital Association Digestive Tumor Committee, Chinese Association of Upper Gastrointestinal Surgeons, Chinese Gastric Cancer Association, and the Gastrointestinal Surgical Group of Chinese Surgical Society Affiliated to Chinese Medical Association, to discuss and formulate this consensus. Results A consensus was reached on the diagnosis and treatment of GCLM. Moreover, we have developed a new clinical classification system, the Chinese Type for Gastric Cancer Liver Metastases, based on the likelihood of a surgical treatment being successful. Conclusions The MDT mode should be implemented throughout all treatment of GCLM.A Chinese version of this expert consensus has been published in the Chinese Journal of Practical Surgery (Volume 39, Issue 10, p. 405-411). Written permission was obtained from the Chinese Journal of Practical Surgery to disseminate the expert consensus in English.
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Affiliation(s)
- Kecheng Zhang
- Department of General Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Lin Chen
- Department of General Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China
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14
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Conversion Surgery in Metastatic Gastric Cancer and Cancer Dormancy as a Prognostic Biomarker. Cancers (Basel) 2019; 12:cancers12010086. [PMID: 31905818 PMCID: PMC7016667 DOI: 10.3390/cancers12010086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/23/2019] [Accepted: 12/24/2019] [Indexed: 12/24/2022] Open
Abstract
The role of conversion surgery in metastatic gastric cancer remains unclear. Cancer dormancy markers might have a role in predicting the survival in patients with conversion surgery. We identified 26 patients who went through conversion surgery, i.e., a curative-intent gastrectomy with metastasectomy after chemotherapy in initially metastatic gastric cancer. As controls, 114 potential candidates for conversion surgery who only received chemotherapy were included for the propensity score matching. Conversion surgery showed a significantly longer overall survival (OS) compared with only palliative chemotherapy (median-43.6 vs. 14.0 months, respectively, p < 0.001). This better survival in the conversion surgery group persisted even after propensity matching (p < 0.001), and also when compared to patients with tumor response over 5.1 months in the chemotherapy only group (p = 0.005). In the conversion surgery group, OS was longer in patients with R0 resection (22/26, 84.6%) than without R0 resection (4/26, 15.4%) (median-not reached vs 22.1 months, respectively, p = 0.005). Although it should be interpreted with caution due to the primitive analysis in a small population, the positive expression of NR2F1 showed a longer duration of disease-free survival (DFS) after conversion surgery (p = 0.016). In conclusion, conversion surgery showed a durable OS even in patients with initially metastatic gastric cancer when R0 resection was achieved after chemotherapy.
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15
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Ma F, Li Y, Li W, Kang W, Liu H, Ma S, Xie Y, Zhong Y, Xu Q, Wang B, Xue L, Tian Y. Metastasectomy Improves the Survival of Gastric Cancer Patients with Krukenberg Tumors: A Retrospective Analysis of 182 patients. Cancer Manag Res 2019; 11:10573-10580. [PMID: 31908529 PMCID: PMC6927488 DOI: 10.2147/cmar.s227684] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 11/21/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE There is no consensus regarding whether metastasectomy in gastric cancer patients with Krukenberg tumors (KTs) is associated with survival benefits. The aim of this study was to evaluate the treatment of KTs of gastric origin in a large series of patients and to identify prognostic factors affecting survival. PATIENTS AND METHODS All patients who were diagnosed with gastric cancer and ovarian metastases in a single medical center between January 2006 and December 2016 were identified and included. The patients were divided into two groups according to treatment modality: a metastasectomy group and a nonmetastasectomy group. Clinicopathological features and overall survival (OS) were compared between the groups. RESULTS In total, 182 patients were identified; 94 patients presented with synchronous KTs, and 88 developed metachronous KTs during follow-up. OS was significantly longer in the metastasectomy group than in the nonmetastasectomy group among those with synchronous (14.0 months vs 8.0 months; p = 0.001) and metachronous (14 months vs 8 months; p = 0.018) KTs. Multivariate analysis indicated that metastasectomy (hazard ratio [HR] 0.537; 95% confidence interval [CI] 0.344-0.839; p = 0.006), ascites (HR 1.523; 95% CI 1.058-2.193; p = 0.024), linitis plastica (HR 1.995; 95% CI 1.115-3.571; p = 0.020), and systemic chemotherapy (HR 0.456; 95% CI 0.280-0.742; p = 0.002) were independent predictors of OS. CONCLUSION Metastasectomy combined with systemic chemotherapy should be performed in gastric cancer patients with synchronous or metachronous KTs. Metastasectomy, systemic therapy, linitis plastica, and ascites are prognostic factors for OS. Further prospective randomized studies are needed.
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Affiliation(s)
- Fuhai Ma
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing100021, People’s Republic of China
| | - Yang Li
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing100021, People’s Republic of China
| | - Weikun Li
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing100021, People’s Republic of China
| | - Wenzhe Kang
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing100021, People’s Republic of China
| | - Hao Liu
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing100021, People’s Republic of China
| | - Shuai Ma
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing100021, People’s Republic of China
| | - Yibin Xie
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing100021, People’s Republic of China
| | - Yuxin Zhong
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing100021, People’s Republic of China
| | - Quan Xu
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing100021, People’s Republic of China
| | - Bingzhi Wang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing100021, People’s Republic of China
| | - Liyan Xue
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing100021, People’s Republic of China
| | - Yantao Tian
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing100021, People’s Republic of China
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16
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Choi YW, Ahn MS, Jeong GS, Lee HW, Jeong SH, Kang SY, Park JS, Choi JH, Son SY, Hur H, Han SU, Sheen SS. The role of surgical resection before palliative chemotherapy in advanced gastric cancer. Sci Rep 2019; 9:4136. [PMID: 30858457 PMCID: PMC6411914 DOI: 10.1038/s41598-019-39432-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 01/21/2019] [Indexed: 12/16/2022] Open
Abstract
The role of palliative surgical resection in recurrent or metastatic gastric cancer is still controversial. A retrospective review was conducted on 689 patients who received palliative chemotherapy for recurrent (n = 307) or primary metastatic (n = 382) gastric cancer. Among 131 patients (89 primary metastatic and 42 recurrent) with surgical resection before chemotherpay, 75 underwent gastrectomy, 42 metastasectomy, and 14 gastrectomy with metastasectomy. The median overall survival (OS) of patients who underwent surgical resection was significantly longer than that of patients who received chemotherapy alone (18 vs. 9 months, p < 0.0001). The OS benefit of surgical resection was consistent across subgroups. In multivariate analysis, surgical resection was independently associated with favorable OS (hazard ratio = 0.42, p < 0.0001). Moreover, patients with surgical resection showed favorable OS both in univariate (p < 0.0001) and multivariate (p < 0.0001) analysis even after propensity score matching. In addition, the median OS of patients who underwent gross complete resection (n = 54) was significantly longer than that of patients who underwent incomplete resection (n = 77) (30 vs. 15 months, p = 0.002). The present study suggests that judicious use of surgical resection before chemotherapy in recurrent or metastatic gastric cancer patients may result in a favorable outcome, especially when complete resection is achievable.
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Affiliation(s)
- Yong Won Choi
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Mi Sun Ahn
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Geum Sook Jeong
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Woo Lee
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Seong Hyun Jeong
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Seok Yun Kang
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea.
| | - Joon Seong Park
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Jin-Hyuk Choi
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea.
| | - Sang-Yong Son
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Sang-Uk Han
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Seung Soo Sheen
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea
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17
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Molfino S, Ballarini Z, Gheza F, Portolani N, Baiocchi GL. Is there a role for treatment-oriented surgery in stage IV gastric cancer? A systematic review. Updates Surg 2019; 71:21-27. [PMID: 30039281 DOI: 10.1007/s13304-018-0571-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 06/30/2018] [Indexed: 12/19/2022]
Abstract
To analyze the available evidence on the role of treatment-oriented surgery in stage IV gastric cancer (metastatic disease), a systematic literature search was undertaken using Medline, Embase, Cochrane, and Web-of-Science libraries. The search was not restricted to articles published within a given year range. Articles written in English language (or with abstracts written in English) were considered. All references in the chosen articles were further screened to find additional relevant publications. Both clinical series and literature reviews were included. Stage IV gastric cancer is classified into four subcategories: positive peritoneal cytology without clear macroscopic peritoneal involvement (surgery is usually performed in these cases); gross appearance peritoneal carcinomatosis [surgery, eventually with hyperthermic intraoperative peritoneal chemotherapy (HIPEC) may be considered in very selected cases with limited PCI]; nodal metastases outside the loco-regional nodes (surgery may not be denied for metastatic nodes in stations 13 and 16); and hematogenous metastases (surgery should be performed in selected cases with liver metastases suitable to R0 resection). The analysis incorporated the new biological classification of stage IV gastric cancer recently proposed by Japanese researchers (Yoshida et al. in Gastric Cancer 19:329-338. https://doi.org/10.1007/s10120-015-0575-z , 2015) into the four aforementioned subcategories to make the comparison of the issues discussed meaningful. The take home message from the existing literature is that treatment-oriented surgery may be performed in a significant proportion of patients with stage IV gastric cancer.
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Affiliation(s)
- Sarah Molfino
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Zeno Ballarini
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy.
- Chirurgia Generale 3, Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy.
| | - Federico Gheza
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Nazario Portolani
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
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18
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Korean Practice Guideline for Gastric Cancer 2018: an Evidence-based, Multi-disciplinary Approach. J Gastric Cancer 2019; 19:1-48. [PMID: 30944757 PMCID: PMC6441770 DOI: 10.5230/jgc.2019.19.e8] [Citation(s) in RCA: 309] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 12/13/2022] Open
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19
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Yang LP, Wang ZX, He MM, Jin Y, Ren C, Wang ZQ, Wang FH, Li YH, Wang F, Xu RH. The survival benefit of palliative gastrectomy and/or metastasectomy in gastric cancer patients with synchronous metastasis: a population-based study using propensity score matching and coarsened exact matching. J Cancer 2019; 10:602-610. [PMID: 30719157 PMCID: PMC6360412 DOI: 10.7150/jca.28842] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 12/08/2018] [Indexed: 02/07/2023] Open
Abstract
Introduction: Palliative surgeries were controversial for asymptomatic metastatic gastric cancer (mGC) patients. This study was aimed to evaluate survival benefit of palliative surgeries to gastric and/or metastatic tumors in mGC patients based on U.S population. Materials and Methods: A total of 8345 gastric cancer patients diagnosed with synchronous distal metastasis between 2004 to 2013 from the Surveillance, Epidemiology, and End Results Program (SEER) database were divided into four groups according to surgery strategies: surgeries to both primary and metastatic tumors (SPM), gastrectomy only (GO), metastasectomy only (MO) and no surgery performed (NS). Their clinicopathological characteristics and overall survival (OS) were analyzed before and after propensity score matching (PSM) and coarsened exact matching (CEM). Results: The median OS of SPM and GO patients was both significantly higher than NS patients (11 months vs. 8 months vs. 5 months; P<0.001, respectively) while that of MO was not (6 months vs. 5 months; P= 0.286). In comparisons between surgery strategies, survival benefit was similar between SPM and GO groups (P=0.389) and both showed significantly better survival than MO patients (P<0.001). All surgery strategies were proved to be favorable prognostic factors over non-surgical treatment (Hazard ratio (HR) for SPM: 0.60, P<0.001; HR for GO: 0.62, P<0.001; HR for MO: 0.91, P=0.046). Similar results were obtained after matching by PSM and CEM except that prognostic impact of MO deteriorated. Conclusions: Gastrectomy plus metastasectomy or gastrectomy alone could be adopted as a choice of improving survival in the U.S population. Metastasectomy alone is not generally recommended.
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Affiliation(s)
- Lu-Ping Yang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Zi-Xian Wang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Ming-Ming He
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Ying Jin
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Chao Ren
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Zhi-Qiang Wang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Feng-Hua Wang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yu-Hong Li
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Feng Wang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Rui-Hua Xu
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
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20
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Wu P, Wang P, Ma B, Yin S, Tan Y, Hou W, Wang Z, Xu H, Zhu Z. Palliative gastrectomy plus chemotherapy versus chemotherapy alone for incurable advanced gastric cancer: a meta-analysis. Cancer Manag Res 2018; 10:4759-4771. [PMID: 30464590 PMCID: PMC6208494 DOI: 10.2147/cmar.s179368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Whether palliative gastrectomy combined with chemotherapy can improve the survival of patients with advanced gastric cancer remains controversial. We performed a meta-analysis to clarify whether palliative gastrectomy plus chemotherapy can benefit patients with incurable advanced gastric cancer and to explore the best candidates in this patient population. METHODS We searched the literature systematically using electronic databases including PubMed, EMBASE, and the Cochrane Library. And HRs and their 95% CIs were used to express the results for overall survival (OS) and progression-free survival (PFS). RESULTS One randomized controlled trial with 175 patients and 12 cohort studies with 2,193 patients were analyzed. The pooled HR for OS (HR=0.43, 95% CI=0.29-0.65, P<0.001), subgroup analysis of stage M1 (HR=0.53, 95% CI=0.40-0.72, P<0.001), peritoneal dissemination (HR=0.46, 95% CI=0.28-0.73, P=0.001), and liver metastasis (HR=0.46, 95% CI=0.33-0.65, P<0.001) all indicated the superiority of palliative gastrectomy plus chemotherapy. However, the pooled HR for PFS (HR=0.61, 95% CI=0.33-1.13, P=0.110) got separate outcome. CONCLUSION The results of this meta-analysis indicated that palliative gastrectomy plus chemotherapy can improve OS for incurable advanced gastric cancer. In addition, analyses based on liver metastasis and peritoneal dissemination demonstrated the advantages of palliative gastrectomy plus chemotherapy. However, the PFS of incurable advanced gastric cancer with palliative gastrectomy plus chemotherapy was no better than that under chemotherapy alone.
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Affiliation(s)
- Pei Wu
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang 110001, China,
| | - Pengliang Wang
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang 110001, China,
| | - Bin Ma
- Department of Colorectal Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Dadong District, Shenyang 110042, Liaoning Province, China
| | - Songcheng Yin
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang 110001, China,
| | - Yuen Tan
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang 110001, China,
| | - Wenbin Hou
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang 110001, China,
| | - Zhenning Wang
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang 110001, China,
| | - Huimian Xu
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang 110001, China,
| | - Zhi Zhu
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang 110001, China,
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Xiao SM, Xu R, Tang XL, Ding Z, Li JM, Zhou X. Conversion therapy for advanced gastric cancer with trastuzumab combined with chemotherapy: A case report. Oncol Lett 2018; 16:2085-2090. [PMID: 30008904 PMCID: PMC6036458 DOI: 10.3892/ol.2018.8942] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 07/14/2017] [Indexed: 12/23/2022] Open
Abstract
Gastric cancer is a common cancer of the gastrointestinal tract and the second most prevalent cause of cancer-associated mortality globally. Gastric cancer-associated mortality is increased in China compared with that in other countries. Key contributors to the poor prognosis of gastric cancer include late clinical presentation and genetic heterogeneity. Treatment based on the subtype of gastric cancer is important for effective therapy. The overexpression of the erb-b2 receptor tyrosine kinase 2 (ERBB2) gene and protein is associated with gastric cancer in humans. Chemotherapy and targeted therapy may control tumor growth and recurrence, which is an important function of conversion surgery. The present study reported a patient diagnosed with gastric cancer with multiple abdominal cavity and retroperitoneal lymph node metastases. ERBB2 amplification and overexpression were identified in both case reports presented. The patients were treated with four cycles of oxaliplatin, capecitabine and trastuzumab. Computed tomography revealed the lymph node metastases decreased in size following treatment, and surgical resection was performed. The four cycles of oxaliplatin, capecitabine and trastuzumab were continued subsequent to surgical resection at the administered dose. No recurrence was observed for >1 year after surgery. Trastuzumab combined with oxaliplatin and capecitabine as a conversion therapy regime for ERBB2-overexpressing advanced gastric adenocarcinoma increased the likelihood of successful surgical resection, and prolonged progression-free survival.
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Affiliation(s)
- Shuo-Meng Xiao
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, Chengdu, Sichuan 610041, P.R. China
| | - Rui Xu
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, Chengdu, Sichuan 610041, P.R. China
| | - Xiao-Li Tang
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, Chengdu, Sichuan 610041, P.R. China
| | - Zhi Ding
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, Chengdu, Sichuan 610041, P.R. China
| | - Ji-Man Li
- Department of Pathology, Sichuan Cancer Hospital, Chengdu, Sichuan 610041, P.R. China
| | - Xiang Zhou
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, Chengdu, Sichuan 610041, P.R. China
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22
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PD-L1 Expression Predicts a Distinct Prognosis in Krukenberg Tumor with Corresponding Origins. J Immunol Res 2018; 2018:9485285. [PMID: 29854854 PMCID: PMC5964418 DOI: 10.1155/2018/9485285] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/04/2018] [Indexed: 12/12/2022] Open
Abstract
Krukenberg tumor (KT) is an uncommon ovarian metastatic signet-ring cell adenocarcinoma that mostly metastasizes from gastrointestinal carcinoma. Optimal treatment options for KTs are limited. Programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitors have shown remarkable activity in clinical trials for metastatic tumors. Here, we evaluated PD-L1 expression and T cell infiltration in KTs and their corresponding primary tumors. Positive tumor PD-L1 expression was detected in 9 (25.7%) KTs from gastric carcinomas (GCs) and in 20 (66.7%) KTs from colorectal carcinomas (CRCs). Patient survival was assessed according to the PD-L1 status and CD8+ T cell density. Positive tumor PD-L1 expression in KTs from GCs was associated with poor prognosis. In contrast, positive tumor PD-L1 expression in KTs from CRCs was associated with an improved prognosis. We analyzed copy number variations of the PD-L1 gene in KTs. PD-L1 expression was higher in cases with copy number gains. The T cell densities within KTs and their corresponding primary tumors were compared. The densities of CD8+ T cells correlated significantly between the primary tumors and KTs from the same case. Taken together, the research further highlighted targets for immune-based therapy in KTs from GCs and CRCs.
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23
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Schizas D, Lazaridis II, Moris D, Mastoraki A, Lazaridis LD, Tsilimigras DI, Charalampakis N, Liakakos T. The role of surgical treatment in isolated organ recurrence of esophageal cancer-a systematic review of the literature. World J Surg Oncol 2018; 16:55. [PMID: 29540179 PMCID: PMC5853115 DOI: 10.1186/s12957-018-1357-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 03/06/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite the improvements in the early detection and treatment of non-metastatic esophageal cancer, more than half of patients undergoing a curative treatment for esophageal cancer will develop recurrence within three years. The prognosis of these patients is poor. However, a wide range in overall survival has been reported, depending on the pattern of recurrence, and no optimal treatment strategy following recurrence has yet been uniformly accepted. AIM In this article, we aimed to systematically review the literature for the role of surgical resection of metachronous distant metastasis following primary treatment of esophageal cancer. Furthermore, we discuss possible factors that could possibly predict which patients may benefit from a surgical approach. A comprehensive literature search was conducted in PubMed using combinations of keywords. RESULTS Patients with recurrence may benefit of a multimodality treatment. Regarding the isolated recurrence of esophageal cancer in solid visceral organs, operative intervention has been proposed as a treatment that may offer a survival benefit in an individual basis. No definitive conclusions regarding the potential survival advantage offered by the surgical treatment of solitary recurrent lesions can be drawn. However, recent improvements in surgical treatment and optimization of perioperative management guarantee an acceptable operative risk, making surgical resection of solitary recurrence lesions a considerable therapeutic option. CONCLUSIONS It can be conferred from the available studies that the surgical treatment of isolated recurrence from esophageal cancer may offer a survival benefit for properly selected patients. Prospective, multicenter studies might be useful to gain a better insight into those factors that affect selection of patients to take benefit from an operative intervention.
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Affiliation(s)
- Dimitrios Schizas
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma Str., Goudi, 11527, Athens, Greece.
| | | | - Demetrios Moris
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma Str., Goudi, 11527, Athens, Greece
| | - Aikaterini Mastoraki
- Fourth Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Lazaros-Dimitrios Lazaridis
- Hepatogastroenterology Unit, Second Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Theodore Liakakos
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma Str., Goudi, 11527, Athens, Greece
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24
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Mönig SP, Schiffmann LM. [Resection of advanced esophagogastric adenocarcinoma : Extended indications]. Chirurg 2018; 87:398-405. [PMID: 27138270 DOI: 10.1007/s00104-016-0183-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In the current German S3 guidelines surgical treatment is not recommended for metastatic gastric cancer or metastatic adenocarcinoma of the esophagogastric junction; however, in routine practice the indications can be extended so that there may be occasions in which radical surgical intervention for specific individuals may be appropriate as part of a multimodal therapy with curative intent. This article presents the scientific rationale of such an approach based on the available literature considering modern, multimodal therapy concepts including criteria to be met for radical surgery. Currently only retrospective trials and limited current meta-analysis data are available for justifying surgical treatment for metastatic adenocarcinoma. The recently published initial results of the FLOT-3 study identified a patient subgroup that benefits from a resection even though metastasis has occurred. Whether surgical therapy will become an integral part of the treatment of limited metastatic adenocarcinoma of the stomach and esophagus in the future, has to be demonstrated by large prospective randomized studies, such as the RENAISSANCE/FLOT-5 study.
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Affiliation(s)
- S P Mönig
- Klinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland. .,Service de Chirurgie viscéral, Hôpitaux Universitaires de Genève, Rue Gabrielle Perret-Gentil 4, CH-1211, Genève, Switzerland.
| | - L M Schiffmann
- Klinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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25
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Choi YJ, Kim DH, Han HS, Han JH, Son SM, Kim DS, Yun HY. Long-term survival after gastrectomy and metastasectomy for gastric cancer with synchronous bone metastasis. World J Gastroenterol 2018; 24:150-156. [PMID: 29358891 PMCID: PMC5757120 DOI: 10.3748/wjg.v24.i1.150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 11/18/2017] [Accepted: 11/27/2017] [Indexed: 02/06/2023] Open
Abstract
Bone metastasis is a rare event in patients with gastric cancer, but pathologic fracture, paralysis, pain and hematological disorders associated with the bone metastasis may influence the quality of life. We report herein the case of a 53-year-old man who presented with primary remnant gastric cancer with bone metastasis. The patient requested further investigations after detection of a metastatic lesion in the 2nd lumbar vertebra during evaluation for back pain that had persisted for 3 mo. No other metastatic lesions were detected. He underwent total gastrectomy and palliative metastasectomy to aid in reduction of symptoms, and he received combination chemotherapy with tegafur (S-1) and cisplatin. The patient survived for about 60 mo after surgery. Currently, there is no treatment guideline for gastric cancer with bone metastasis, and we believe that gastrectomy plus metastasectomy may be an effective therapeutic option for improving quality of life and survival in patients with resectable primary gastric cancer and bone metastasis.
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Affiliation(s)
- Young Jin Choi
- Department of Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, South Korea
| | - Dae Hoon Kim
- Department of Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, South Korea
| | - Hye Suk Han
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, South Korea
| | - Joung-Ho Han
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, South Korea
| | - Seung-Myoung Son
- Department of Pathology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, South Korea
| | - Dong Soo Kim
- Department of Orthopedics, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, South Korea
| | - Hyo Yung Yun
- Department of Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, South Korea
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26
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α-Actinin-4 promotes metastasis in gastric cancer. J Transl Med 2017; 97:1084-1094. [PMID: 28581489 DOI: 10.1038/labinvest.2017.28] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 12/08/2016] [Accepted: 01/16/2017] [Indexed: 12/12/2022] Open
Abstract
Metastasis increases the mortality rate of gastric cancer, which is the third leading cause of cancer-associated deaths worldwide. This study aims to identify the genes promoting metastasis of gastric cancer (GC). A human cell motility PCR array was used to analyze a pair of tumor and non-tumor tissue samples from a patient with stage IV GC (T3N3M1). Expression of the dysregulated genes was then evaluated in GC tissue samples (n=10) and cell lines (n=6) via qPCR. Expression of α-actinin-4 (ACTN4) was validated in a larger sample size (n=47) by qPCR, western blot and immunohistochemistry. Knockdown of ACTN4 with specific siRNAs was performed in GC cells, and adhesion assays, transwell invasion assays and migration assays were used to evaluate the function of these cells. Expression of potential targets of ACTN4 were then evaluated by qPCR. Thirty upregulated genes (greater than twofold) were revealed by the PCR array. We focused on ACTN4 because it was upregulated in 6 out of 10 pairs of tissue samples and 5 out of 6 GC cell lines. Further study indicated that ACTN4 was upregulated in 22/32 pairs of tissue samples at stage III &IV (P=0.0069). Knockdown of ACTN4 in GC cells showed no significant effect on cell proliferation, but significantly increased cell-matrix adhesion, as well as reduced migration and invasion of AGS, MKN7 and NCI-N87 cells. We found that NF-κB was downregulated in GC with the knockdown of ACTN4. In conclusion, this is the first study to indicate that ACTN4 is significantly upregulated in patients with metastatic GC. ACTN4 reduces cell adhesion and enhances migration and invasion of GC cells and may therefore be a novel therapeutic target for GC.
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27
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Kim B, Kim YS, Ahn HM, Lee HJ, Jung MK, Jeong HY, Choi DK, Lee JH, Lee SR, Kim JM, Lee DS. Peroxiredoxin 5 overexpression enhances tumorigenicity and correlates with poor prognosis in gastric cancer. Int J Oncol 2017; 51:298-306. [PMID: 28535004 DOI: 10.3892/ijo.2017.4013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/07/2017] [Indexed: 11/05/2022] Open
Abstract
Gastric cancer is one of the leading causes of cancer-related deaths worldwide. Despite the advanced surgical resection techniques and anticancer drugs currently available to treat early stage gastric cancer, the prognosis of patients with gastric cancer remains poor. The epithelial to mesenchymal transition (EMT) is an important process for the initiation of tumorigenesis. Recent studies suggested that reactive oxygen species (ROS) can promote cell migration and invasion. Thus, an imbalance of redox homeostasis can result in cancer cells exhibiting EMT properties. PRXs are upregulated in various tumors in the breast, bladder, lung, cervical, ovarian, prostate, esophageal, and hepatocellular. However, PRX expression and its impact on disease prognosis, patient survival rate, and EMT are rarely studied in the context of human gastric cancer. The expression of PRX5 was significantly correlated with tumor size, depth of tumor, lymphatic invasion in patients of gastric cancer. In addition, overexpression of PRX5 enhanced carcinogenicity by increasing the proliferation and invasiveness of gastric cancer cells via upregulation of Snail. Taken together, we suggest that PRX5 may be a potential factor that may contribute to poor prognosis of gastric cancer through enhancing the mesenchymal phenotype. Finally, PRX5 is a putative therapeutic target and clinical strategy for various cancers overexpressing PRX5.
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Affiliation(s)
- Bokyung Kim
- School of Life Sciences and Biotechnology, BK21 Plus KNU Creative BioResearch Group, Kyungpook National University, Daegu, Republic of Korea
| | - Yeon Soo Kim
- Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University, Daejeon, Republic of Korea
| | - Hye-Mi Ahn
- School of Life Sciences and Biotechnology, BK21 Plus KNU Creative BioResearch Group, Kyungpook National University, Daegu, Republic of Korea
| | - Hyo Jin Lee
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Min Kyu Jung
- Department of Pathology and Medical Science, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Hyun Yong Jeong
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Dong Kyu Choi
- New Drug Development Center, Daegu-Gyeongbuk Medical Innovation Foundation (DGMIF), Daegu, Republic of Korea
| | - Jun Hyeog Lee
- School of Life Sciences and Biotechnology, BK21 Plus KNU Creative BioResearch Group, Kyungpook National University, Daegu, Republic of Korea
| | - Sang-Rae Lee
- The National Primate Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), Ochang, Republic of Korea
| | - Jin Man Kim
- Department of Pathology and Medical Science, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Dong-Seok Lee
- School of Life Sciences and Biotechnology, BK21 Plus KNU Creative BioResearch Group, Kyungpook National University, Daegu, Republic of Korea
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28
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Li J, Zhang K, Gao Y, Xi H, Cui J, Liang W, Cai A, Wei B, Chen L. Evaluation of hepatectomy and palliative local treatments for gastric cancer patients with liver metastases: a propensity score matching analysis. Oncotarget 2017; 8:61861-61875. [PMID: 28977910 PMCID: PMC5617470 DOI: 10.18632/oncotarget.18709] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 05/23/2017] [Indexed: 12/14/2022] Open
Abstract
Background The optimal treatments for gastric cancer with liver metastases (GCLM) remain controversial. This study aimed to evaluate the efficacy of hepatectomy, RFA and TACE as local treatments for GCLM. Methods From 2001 to 2015, 119 consecutive patients who received multidisciplinary treatments based on curative gastrectomy and local treatments (hepatectomy, RFA and TACE) for liver metastases were enrolled in this retrospective cohort study. Patients were divided into Group A (46, hepatectomy) and Group B (73, either or both RFA and TACE). Propensity score matching analysis was employed. Results The propensity model revealed that hepatectomy was associated with significantly longer OS compared with either or both RFA and TACE (P=0.021). The 1-, 3- and 5-year OS rates were 80.5%, 41.5% and 24.4%, respectively in Group A; and 85.4%, 21.9% and 12.2%, respectively in Group B. Subgroup analyses indicated that hepatectomy was associated with significantly longer long-term survival compared with TACE (P=0.033) and RFA (P=0.010). TACE had a similar efficacy as RFA (P=0.518), but with significantly lower costs (P=0.014) in for patients with metachronous GCLM. Conclusion Hepatectomy is the optimal local treatment for GCLM when surgical R0 resection is intended. TACE attained a similar prognosis as RFA with relatively high cost-effectiveness, particularly for patients with metachronous GCLM.
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Affiliation(s)
- Jiyang Li
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Kecheng Zhang
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Yunhe Gao
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Hongqing Xi
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Jianxin Cui
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Wenquan Liang
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Aizhen Cai
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Bo Wei
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Lin Chen
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China
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29
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Li S, Lan X, Gao H, Wang W, Chen L, Song S, Xue Y. Addition of peritonectomy to gastrectomy can predict good prognosis of gastric adenocarcinoma patients with intraoperatively proven single P1/P2 carcinomatosis. Tumour Biol 2017; 39:1010428317697567. [PMID: 28618957 DOI: 10.1177/1010428317697567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
This study was to evaluate the prognosis of peritonectomy following gastrectomy for gastric adenocarcinoma patients with intraoperatively proven single P1/P2 carcinomatosis and to define the best therapeutic strategy of the patient cohort. The patients with intraoperatively proven single P1/P2 carcinomatosis from a prospectively maintained database were divided into resection group and non-resection group based on complete gross resection of peritoneal carcinomatosis. From 2005 to 2012, there were 103 patients in the resection group and 122 patients in the non-resection group. There was no difference in morbidity and mortality between groups. The patients did not have improved median survival in P1 carcinomatosis compared to P2 carcinomatosis (15.53 vs 14.80 months, p = 0.450). The median survival was significantly improved in the resection group compared to the patients in the non-resection group (21.07 vs 13.37 months, p < 0.001). The patients undergoing complete gross peritonectomy plus postoperative chemotherapy had a significantly longer median survival than patients who had complete gross peritonectomy alone, patients receiving postoperative chemotherapy alone, and patients receiving neither peritonectomy nor postoperative chemotherapy (27.33 vs 12.00 vs 16.00 vs 10.33 months, p < 0.001). In the multivariate analysis, poor performance status ( p = 0.036), absence of complete gross peritonectomy ( p < 0.001), and lack of postoperative chemotherapy ( p < 0.001) were identified as independently associated with poor survival. The data indicate complete gross peritonectomy following gastrectomy confers a survival benefit to gastric cancer patients with intraoperatively proven single P1/P2 carcinomatosis. In addition, postoperative chemotherapy improves survival regardless of resection of peritoneal carcinomatosis and should be recommended.
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Affiliation(s)
- Sen Li
- 1 Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xiuwen Lan
- 1 Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Hongyu Gao
- 1 Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Wenpeng Wang
- 2 Department of Gynecologic Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Chen
- 1 Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Shubin Song
- 1 Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yingwei Xue
- 1 Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin, China
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30
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Kondo T, Kitayama H, Sugiyama J, Hirayama M, Suzuki Y, Oyamada Y, Tsuji Y. Conversion therapy of gastric cancer with massive malignant ascites and ovarian metastases by systemic and intraperitoneal chemotherapy. Mol Clin Oncol 2017; 5:740-744. [PMID: 28105352 PMCID: PMC5228553 DOI: 10.3892/mco.2016.1058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 09/23/2016] [Indexed: 11/14/2022] Open
Abstract
Intravenous and intraperitoneal paclitaxel with S-1 is showing promising results in gastric cancer with peritoneal metastases. We herein report a successful conversion of unresectable to resectable disease using combination chemotherapy with trastuzumab. The patient was a 39-year-old woman with human epidermal growth factor receptor 2-positive gastric cancer with peritoneal, pulmonary and bilateral ovarian metastases. After 6 cycles of S-1 plus cisplatin with trastuzumab, followed by 15 cycles of intravenous and intraperitoneal paclitaxel with S-1 and trastuzumab, the pulmonary and peritoneal metastases exhibited complete response and no evidence of malignancy was found on diagnostic laparoscopy. We performed metastasectomy of the bilateral sizeable ovaries, followed by total gastrectomy. The patient had no recurrence for 16 months after the gastrectomy. Therefore, satisfactory response to systemic and intraperitoneal chemotherapy may convert unresectable to resectable disease, and primary tumor resection with ovarian metastasectomy may prolong survival. This combination chemotherapy has the potential of becoming a conversion therapy for gastric cancer with peritoneal metastases, even if ascites and ovarian metastases are extensive.
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Affiliation(s)
- Tomohiro Kondo
- Department of Medical Oncology, Tonan Hospital, Sapporo, Hokkaido 060-0001, Japan
| | - Hiromitsu Kitayama
- Department of Medical Oncology, Tonan Hospital, Sapporo, Hokkaido 060-0001, Japan
| | - Junko Sugiyama
- Department of Medical Oncology, Tonan Hospital, Sapporo, Hokkaido 060-0001, Japan
| | - Michiaki Hirayama
- Department of Gastroenterology, Tonan Hospital, Sapporo, Hokkaido 060-0001, Japan
| | - Yoshinori Suzuki
- Department of Surgery, Tonan Hospital, Sapporo, Hokkaido 060-0001, Japan
| | - Yumiko Oyamada
- Department of Surgical Pathology, Tonan Hospital, Sapporo, Hokkaido 060-0001, Japan
| | - Yasushi Tsuji
- Department of Medical Oncology, Tonan Hospital, Sapporo, Hokkaido 060-0001, Japan
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31
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Baiocchi GL, Celotti A, Molfino S, Baggi P, Tarasconi A, Baronio G, Arru L, Gheza F, Tiberio G, Portolani N. Distant nodal metastasis: is it always an unresectable disease? Transl Gastroenterol Hepatol 2017; 2:1. [PMID: 28217751 PMCID: PMC5313284 DOI: 10.21037/tgh.2016.12.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/24/2016] [Indexed: 12/27/2022] Open
Abstract
This article aims at analyzing the published literature concerning the treatment of patients with gastric cancer and distant nodal metastases, actually considered metastatic disease. A systematic search was undertaken using Medline, Embase, Cochrane and Web-of-Science libraries. No specific restriction on year of publication was used; preference was given to English papers. Both clinical series and literature reviews were selected. Only 11 papers address the issue of surgery for nodal basins outside the D2 dissection area. From these papers, in selected cases extended surgery may prove useful in prolonging survival, when a comprehensive therapeutic pathway including chemotherapy is scheduled. In conclusion, in presence of nodal metastases outside the loco-regional nodes, surgery may be considered for metastatic nodes in stations 13 and 16, in selected cases.
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Affiliation(s)
- Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Andrea Celotti
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Sarah Molfino
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Paolo Baggi
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Antonio Tarasconi
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Gianluca Baronio
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Luca Arru
- Department of General and Minimally Invasive Surgery, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Federico Gheza
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Guido Tiberio
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Nazario Portolani
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
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32
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Palliative Gastrectomy Prolongs Survival of Metastatic Gastric Cancer Patients with Normal Preoperative CEA or CA19-9 Values: A Retrospective Cohort Study. Gastroenterol Res Pract 2016; 2016:6846027. [PMID: 27990157 PMCID: PMC5136406 DOI: 10.1155/2016/6846027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 09/18/2016] [Indexed: 12/27/2022] Open
Abstract
Background. Palliative gastrectomy has been suggested to improve survival of patients with metastatic gastric cancer, but limitations in study design and availability of robust prognostic factors have cast doubt on the overall merit of this procedure. Methods. The characteristics and clinical outcomes of 173 patients diagnosed between 2008 and 2012 were analyzed to determine the value of palliative gastrectomy and to identify potential prognostic factors. Results. Median overall patient survival was 6.5 months. To attenuate potential selection bias, patients with adequate performance and survival time of ≥ 2 months since diagnosis were included for risk factor analysis (n = 137). The median overall survival was longer for patients who were younger than 60 years, had better performance status (8.7 versus 6.4 months, P = 0.015), received systemic chemotherapy, or had palliative gastrectomy in univariate analyses. Gastrectomy (P = 0.002) remained statistically significant in multivariate analyses. Subgroup analysis showed that patients aged < 60 years, CEA < 5 ng/mL or CA19-9 < 35 U/mL, obtained a survival advantage from palliative gastrectomy. In fact, palliative gastrectomy doubled overall survival for patients who had normal CEA and/or normal CA19-9. Conclusions. Palliative gastrectomy prolongs the survival of metastatic gastric cancer patients with normal CEA and/or CA19-9 level at the time of diagnosis.
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Lee KW, Lee JH, Kim JW, Kim JW, Ahn S, Kim JH. Population-based outcomes research on treatment patterns and impact of chemotherapy in older patients with metastatic gastric cancer. J Cancer Res Clin Oncol 2016; 142:687-97. [PMID: 26567125 DOI: 10.1007/s00432-015-2075-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 11/03/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE Older patients with cancer are underrepresented in clinical trials, and thus, limited data are available on older patients with metastatic gastric cancer (MGC). This study was conducted to assess patterns of care, and outcomes of chemotherapy and its predictors, in older patients with MGC. METHODS Using the Korean Health Insurance Review and Assessment Service (HIRA) database, a nationwide population-based outcomes study was conducted. From the HIRA database, patients newly diagnosed with MGC in 2010 were identified (N = 1871). RESULTS Patients aged ≥70 years were defined as older patients (N = 792) and those aged <70 years as younger patients (N = 1079). Compared with younger patients, fewer older patients were diagnosed with MGC and received cancer treatment at high-volume medical institutions. Palliative chemotherapy was less frequently administered in older patients than in younger patients. In multivariate analyses, although combination chemotherapy as the first-line treatment (vs. monotherapy) and salvage chemotherapy after first-line chemotherapy (vs. no salvage chemotherapy) conferred more prolonged survival in the entire patient population, first-line combination chemotherapy did not provide an additional survival benefit in older patients compared to monotherapy. CONCLUSIONS We found several barriers for older patients in approaching high-quality medical resources or receiving appropriate treatments. Although age was not an independent prognostic factor for survival in MGC, palliative chemotherapy was less frequently used in older patients. In our analysis, combination chemotherapy as the first-line treatment did not provide an additional benefit to older patients compared to monotherapy.
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Affiliation(s)
- Keun-Wook Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea
| | - Ju Hyun Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea
| | - Jin Won Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea
| | - Ji-Won Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea
| | - Soyeon Ahn
- Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Jee Hyun Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.
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An Unusual Course of Metastatic Gastroesophageal Cancer. Case Rep Oncol Med 2016; 2015:941508. [PMID: 26770853 PMCID: PMC4681789 DOI: 10.1155/2015/941508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/19/2015] [Indexed: 11/17/2022] Open
Abstract
We are reporting on a case of a 41-year-old woman who presented with metastatic gastroesophageal junction cancer and who achieved prolonged survival with a multimodal treatment approach. After initially experiencing robust response to chemotherapy, she was treated for distant recurrence with palliative radiation to the gastrohepatic and supraclavicular lymph nodes and subsequently, given her unusual near-complete response, with reirradiation to the abdomen with curative intent for residual disease. The case presented is unique due to the patient's atypical treatment course, including technically difficult reirradiation to the abdomen, and the resulting prolonged survival despite metastatic presentation.
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Tiberio GAM, Roviello F, Donini A, de Manzoni G, Cancer TIRGFG. Hepatic metastases from gastric cancer: A surgical perspective. World J Gastroenterol 2015; 21:11489-11492. [PMID: 26556981 PMCID: PMC4631955 DOI: 10.3748/wjg.v21.i41.11489] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/09/2015] [Accepted: 09/15/2015] [Indexed: 02/06/2023] Open
Abstract
Management of patients with hepatic metastases as the sole metastatic site at diagnosis of gastric cancer (synchronous setting) or detected during follow-up (metachronous) is controversial. The prevailing attitude in these cases is passive, leading to surgical palliation and, possibly, to chemotherapy. Authors focused this editorial in order to promote a more pragmatic attitude. They stress the importance of recognizing the good candidates to curative surgery of both gastric cancer and hepatic metastases (synchronous setting) or hepatic disease alone (metachronous disease) from those who will not benefit from surgical therapy. In fact, in adequately selected subgroup of patients surgery, especially if integrated in multimodal therapeutic strategies, may achieve unexpected 5-year survival rates, ranging from 10% to 40%. The critical revision of the literature suggests that some simple clinical criteria exist that may be effectively employed in patients selection. These are mainly related to the gastric cancer (factors T, N, G) and to the extent of hepatic involvement (factor H). Upon these criteria it is possible to adequately select about 50% of cases. In the remaining 50% of cases a critical discussion on a case-by-case basis is recommended, considering that among these patients some potential long-survivors exist, that survival is strictly influenced by the ablation of the tumor bulk and by multimodality treatments including chemotherapy and that in expert institutions this kind of surgery is performed with very low mortality and morbidity rates.
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Kwee RM, Kwee TC. Modern imaging techniques for preoperative detection of distant metastases in gastric cancer. World J Gastroenterol 2015; 21:10502-10509. [PMID: 26457011 PMCID: PMC4588073 DOI: 10.3748/wjg.v21.i37.10502] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 04/20/2015] [Accepted: 08/25/2015] [Indexed: 02/06/2023] Open
Abstract
A substantial portion of patients with newly diagnosed gastric cancer has distant metastases (M1 disease). These patients have a very poor prognosis and it is generally accepted that they should be treated with noncurative intent. Because it dramatically changes prognosis and treatment plans, it is very important to diagnose distant metastases. In this article, the definition, pathways, incidence and sites of distant metastases in gastric cancer are described. Subsequently, the current performance of imaging in detecting distant metastases in newly diagnosed gastric cancer is outlined and future prospects are discussed.
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Cho JH, Lim JY, Choi AR, Choi SM, Kim JW, Choi SH, Cho JY. Comparison of Surgery Plus Chemotherapy and Palliative Chemotherapy Alone for Advanced Gastric Cancer with Krukenberg Tumor. Cancer Res Treat 2015; 47:697-705. [PMID: 25648093 PMCID: PMC4614195 DOI: 10.4143/crt.2013.175] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 06/15/2014] [Indexed: 02/06/2023] Open
Abstract
PURPOSE This study was conducted to validate the survival benefit of metastasectomy plus chemotherapy over chemotherapy alone for treatment of Krukenberg tumors from gastric cancer and to identify prognostic factors for survival. MATERIALS AND METHODS Clinical data from 216 patients with Krukenberg tumors from gastric cancer were collected. Patients were divided into two arms according to treatment modality: arm A, metastasectomy plus chemotherapy and arm B, chemotherapy alone. RESULTS Overall survival (OS) was significantly increased in arm A relative to arm B for patients initially diagnosed with stage IV gastric cancer (18.0 months vs. 8.0 months; p < 0.001) and those with recurrent Krukenberg tumors (19.0 months vs. 9.0 months; p=0.002), respectively. Metastasectomy (hazard ratio [HR], 0.458; 95% confidence interval [CI], 0.287 to 0.732; p=0.001), signet-ring cell pathology (HR, 1.583; 95% CI, 1.057 to 2.371; p=0.026), and peritoneal carcinomatosis (HR, 3.081; 95% CI, 1.610 to 5.895; p=0.001) were significant prognostic factors for survival. CONCLUSION Metastasectomy plus chemotherapy offers superior OS when compared to palliative chemotherapy alone in gastric cancer with Krukenberg tumor. Prolonged survival applies to all patients, regardless of gastric cancer stage. Metastasectomy, signet-ring cell pathology, and peritoneal carcinomatosis were prognostic factors for survival. Future prospective randomized trials are needed to confirm the optimal treatment strategy for Krukenberg tumors from gastric cancer.
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Affiliation(s)
- Jang Ho Cho
- Division of Medical Oncology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Yun Lim
- Division of Medical Oncology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ah Ran Choi
- Division of Medical Oncology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Min Choi
- Division of Medical Oncology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Won Kim
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Ho Choi
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Yong Cho
- Division of Medical Oncology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Correspondence: Jae Yong Cho, MD, PhD Division of Medical Oncology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea Tel: 82-2-2019-4363 Fax: 82-2-3463-3882 E-mail:
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Wu F, Zhao X, Mi B, Feng LU, Yuan NA, Lei F, Li M, Zhao X. Clinical characteristics and prognostic analysis of Krukenberg tumor. Mol Clin Oncol 2015; 3:1323-1328. [PMID: 26807242 DOI: 10.3892/mco.2015.634] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/14/2015] [Indexed: 12/13/2022] Open
Abstract
Krukenberg tumor is a rare metastastic tumor of the ovary, characterized by poor prognosis. In order to analyze the clinical characteristics and prognostic factors, we retrospectively investigated 128 patients who were diagnosed with Krukenberg tumor between January, 1990 and December, 2010. The median patient age was 48 years. The median overall survival (OS) of Krukenberg tumor for all patients was 16 months (95% CI: 15-19 months). The median OS among patients with Krukenberg tumors of gastric, colorectal, breast and other origins (including appendix, gallbladder, small intestine and unknown primary) was 11, 21.5, 31 and 19.5 months, respectively (P<0.0001). In the univariate analysis, synchronous metastasis, no chemotherapy, ovarian metastasis beyond the pelvis, ascites and no metastasectomy were identified as significant poor prognostic factors. The multivariate analysis suggested that synchronous metastasis (P=0.0080), pelvic invasion (P=0.0138), ascites (P<0.0001) and no metastasectomy (P=0.0060) were independent factors for predicting unfavorable OS. It was suggested that the prognosis of Krukenberg tumor is dismal and ovarian metastasectomy may prove beneficial. Adequate treatment planning is required for this group of patients.
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Affiliation(s)
- Fang Wu
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi 710061, P.R. China
| | - Xiaoai Zhao
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi 710061, P.R. China
| | - Baibing Mi
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, P.R. China
| | - L U Feng
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi 710061, P.R. China
| | - N A Yuan
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi 710061, P.R. China
| | - Fuxi Lei
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi 710061, P.R. China
| | - Min Li
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi 710061, P.R. China
| | - Xinhan Zhao
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi 710061, P.R. China
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Clinicopathological correlation of keratinocyte growth factor and matrix metalloproteinase-9 expression in human gastric cancer. TUMORI JOURNAL 2015; 101:566-71. [PMID: 26350198 DOI: 10.5301/tj.5000367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2015] [Indexed: 02/01/2023]
Abstract
AIMS AND BACKGROUND Keratinocyte growth factor (KGF) is reported to be implicated in the growth of some cancer cells. Matrix metalloproteinase 9 (MMP-9) is thought to enhance the tumor invasion and metastasis ability. This study was aimed at analyzing the relationship between KGF and MMP-9 expression and patients' clinicopathological characteristics to clarify the clinical significance of the expression of KGF and MMP-9 in gastric cancer. METHODS Tissue samples from 161 patients with primary gastric cancer were investigated using immunohistochemistry. The relationship between KGF and/or MMP-9 expression and clinicopathological characteristics was analyzed. RESULTS KGF expression and MMP-9 expression in gastric cancer tissue were observed in 62 cases (38.5%) and 97 cases (60.2%), respectively. MMP-9 was significantly associated with depth of invasion, lymph node metastasis and TNM stage. The prognosis of MMP-9-positive patients was significantly poorer than that of MMP-9-negative patients (p = 0.009). KGF expression was positively correlated with MMP-9 expression in gastric cancer, and the prognosis of patients with both KGF- and MMP-9-positive tumors was significantly worse than that of patients with negative tumors for either factor (p = 0.045). Expression of MMP-9 was revealed to be an independent prognostic factor (p = 0.026). CONCLUSIONS Coexpression of KGF and MMP-9 in gastric cancer could be a useful prognostic factor, and MMP-9 might also serve as a novel target for both prognostic prediction and therapeutics.
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Lee SE, Choi YS, Kim MK, Oh HC, Do JH. Bilateral ovarian metastasis from distal common bile duct carcinoma developing after choledochal cyst excision. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2015; 19:75-7. [PMID: 26155281 PMCID: PMC4494081 DOI: 10.14701/kjhbps.2015.19.2.75] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 05/15/2015] [Accepted: 05/26/2015] [Indexed: 11/30/2022]
Abstract
Ovarian metastases represent about 3-5% of all ovarian malignancies. Most of these tumors originate in the digestive tract and cholangiocarcinoma rarely involves the ovary. A 60-year-old woman was admitted for the investigation of abdominal distension that had lasted 1 week. One and a half years prior, the patient had undergone choledochal cyst excision, Roux-en Y hepaticojejunostomy and cholecystectomy. Computed tomography scans of the abdomen revealed a papillary mass in the remnant distal common bile duct and enlargement of both ovaries with a huge amount of ascites. An explorative laparotomy disclosed no peritoneal seeding with resectable cholangiocarcinoma and bilateral ovarian mass. Pylorus-preserving pancreatoduodenectomy and bilateral salphingo-oophorectomy with hysterectomy were performed. Histologically, it was a well-differentiated adenocarcinoma and all surgical margins were free of tumor. Both ovarian masses were consistent with metastatic adenocarcinoma from the common bile duct. The patient received six cycles of postoperative adjuvant systemic chemotherapy, dying after 10 months due to pulmonary embolism.
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Affiliation(s)
- Seung Eun Lee
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yoo Shin Choi
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Mi Kyung Kim
- Department of Pathology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyoung-Chul Oh
- Devision of Gastroenterology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae Hyuk Do
- Devision of Gastroenterology, Chung-Ang University College of Medicine, Seoul, Korea
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Yang K, Liu K, Zhang WH, Lu ZH, Chen XZ, Chen XL, Zhou ZG, Hu JK. The Value of Palliative Gastrectomy for Gastric Cancer Patients With Intraoperatively Proven Peritoneal Seeding. Medicine (Baltimore) 2015; 94:e1051. [PMID: 26166075 PMCID: PMC4504616 DOI: 10.1097/md.0000000000001051] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/28/2015] [Accepted: 05/29/2015] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to evaluate the survival benefit of palliative gastrectomy for gastric cancer patients with peritoneal seeding proven intraoperatively and to identify positive predictive factors for improving survival.The value of palliative resection for gastric cancer patients with peritoneal metastasis is controversial.From 2006 to 2013, 267 gastric cancer patients with intraoperatively identified peritoneal dissemination were retrospectively analyzed. Patients were divided into resection group and nonresection group according to whether a palliative gastrectomy was performed. Clinicopathologic variables and survival were compared. Subgroup analyses stratified by clinicopathologic factors and multivariable analysis for overall survival were also performed.There were 114 patients in the resection group and 153 in nonresection group. The morbidities in the resection and nonresection groups were 14.91% and 5.88%, respectively (P = 0.014). There, however, was no difference in mortality between the 2 groups. The median survival time of patients in the resection group was longer than in nonresection group (14.00 versus 8.57 months, P = 0.000). The median survivals among the patients with different classifications of peritoneal metastasis were statistically significant (P = 0.000). Patients undergoing resection followed by chemotherapy had a significantly longer median survival, compared with that of patients who had chemotherapy alone, those who had resection alone, or those who had not received chemotherapy or resection (P = 0.000). Results of subgroup analyses showed that except for P3 patients and patients with multisite distant metastases, overall survival was significantly better in patients with palliative gastrectomy, compared with the nonresection group. In multivariate analysis, P3 disease (P = 0.000), absence of resection (P = 0.000), and lack of chemotherapy (P = 0.000) were identified as independently associated with poor survival.Palliative gastrectomy might be beneficial to the survival of gastric cancer patients with intraoperatively proven P1/P2 alone, rather than P3. Postoperative palliative chemotherapy could improve survival regardless of operation and should be recommended.
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Affiliation(s)
- Kun Yang
- Department of Gastrointestinal Surgery (KY, KL, W-HZ, Z-HL, X-ZC, X-LC, Z-GZ, J-KH); Laboratory of Gastric cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, China (KY, KL, W-HZ, Z-HL, X-ZC, X-LC, J-KH)
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Gadde R, Tamariz L, Hanna M, Avisar E, Livingstone A, Franceschi D, Yakoub D. Metastatic gastric cancer (MGC) patients: Can we improve survival by metastasectomy? A systematic review and meta-analysis. J Surg Oncol 2015; 112:38-45. [PMID: 26074130 DOI: 10.1002/jso.23945] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 05/18/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prognosis with current management strategies continues to be dismal in metastatic gastric cancer (MGC) patients. We aimed to evaluate the role of metastasectomy in improving survival. METHODS A comprehensive search of MEDLINE, EMBASE, SCOPUS, and Cochrane central databases (1965 to present) was performed. All comparative studies measuring survival in MGC patients undergoing metastasectomy versus other therapies were included. Pooled risk ratios with corresponding 95% confidence intervals (CI) were calculated for survival at 1, 3, and 5 years. RESULTS Sixteen studies with 1712 patients (378 patients in metastasectomy, 1334 patients in other therapies) were eligible for the final meta-analysis. Median age was 63 years. For patients undergoing metastasectomy, a significant survival advantage was observed at 1 year (RR 0.52, CI 0.43-0.62), 3 year (RR 0.75 CI 0.67-0.83), and 5 year (RR 0.82, CI 0.74-0.91); mean increased difference in survival conferred by metastasectomy averaged between 9.3 and 15.7 months; P < 0.001 for all results. Age, ECOG status, and STROBE score did not contribute to differences in survival. CONCLUSION Metastasectomy is associated with increased survival at 1, 3, and 5 years in MGC patients. Large prospective randomized controlled trials are critically needed to evaluate the role of metastasectomy in MGC.
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Affiliation(s)
- Rahul Gadde
- Division of Surgical Oncology at Department of Surgery, University of Miami-Miller School of Medicine, Miami, Florida.,Department of Internal Medicine, University of Miami-Miller School of Medicine, Miami, Florida
| | - Leonardo Tamariz
- Department of Internal Medicine, University of Miami-Miller School of Medicine, Miami, Florida
| | - Mena Hanna
- Division of Surgical Oncology at Department of Surgery, University of Miami-Miller School of Medicine, Miami, Florida
| | - Eli Avisar
- Division of Surgical Oncology at Department of Surgery, University of Miami-Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami-Miller School of Medicine, Miami, Florida
| | - Alan Livingstone
- Division of Surgical Oncology at Department of Surgery, University of Miami-Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami-Miller School of Medicine, Miami, Florida
| | - Dido Franceschi
- Division of Surgical Oncology at Department of Surgery, University of Miami-Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami-Miller School of Medicine, Miami, Florida
| | - Danny Yakoub
- Division of Surgical Oncology at Department of Surgery, University of Miami-Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami-Miller School of Medicine, Miami, Florida
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Moenig SP, Meyer HJ, Allum WH, De Manzoni G, Garofalo A, Baltin CTH, Fetzner UK, Hoelscher AH. Third international conference of the European Union Network of Excellence on gastric and esophagogastric junction cancer, Cologne, Germany, June 2012. Gastric Cancer 2015; 18:193-9. [PMID: 24522716 DOI: 10.1007/s10120-014-0347-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 01/13/2014] [Indexed: 02/07/2023]
Abstract
In 2012 the European Union Network of Excellence on gastric and esophagogastric junction cancer (EUNE) held its third conference in Cologne, Germany. The main themes discussed included translational research, standard and audit, early diagnosis, development of surgical treatment, adequate surgery for EGJ cancer, adjuvant and neoadjuvant treatment, prevention of peritoneal carcinomatosis and finally education and training. The meeting was attended by 150 experts from 18 different countries.
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Affiliation(s)
- Stefan Paul Moenig
- Department of General-, Visceral- and Cancer Surgery, University Hospital of Cologne, 50973, Cologne, Germany,
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Mohri Y, Tanaka K, Ohi M, Saigusa S, Yasuda H, Toiyama Y, Araki T, Inoue Y, Kusunoki M. Identification of prognostic factors and surgical indications for metastatic gastric cancer. BMC Cancer 2014; 14:409. [PMID: 24906485 PMCID: PMC4057566 DOI: 10.1186/1471-2407-14-409] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 05/29/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The treatment of metastatic gastric cancer is not uniform, and the prognostic factors and indications for surgery are currently unclear. This retrospective study aimed to identify the prognostic factors and clinical indications for surgery in patients with metastatic gastric cancer. METHODS A total of 123 consecutive patients with gastric cancer and synchronous distant metastasis treated between January 1999 and December 2011 were reviewed. Patient, tumor, laboratory, surgical, and chemotherapy factors were analyzed, with overall survival as the endpoint. Univariate analyses were performed using the log-rank test, multivariate analyses were performed using the Cox proportional hazards model, and Kaplan-Meier curves were used to estimate survival. Significance was set at p<0.05. RESULTS The median overall survival time was 13.1 months. Ninety-eight patients received chemotherapy. Twenty-eight patients underwent gastrectomy with metastasectomy and 55 underwent gastrectomy without metastasectomy. The median overall survival time for patients who underwent gastrectomy with metastasectomy, gastrectomy without metastasectomy, and no surgical intervention was 21.9 months, 12.5 months, and 7.2 months, respectively (p<0.001). Multivariate analysis identified gastrectomy with or without metastasectomy, performance status (PS) ≥ 3, neutrophil-to-lymphocyte ratio (NLR) >3.1, and carbohydrate antigen 19-9 (CA19-9) level >37 U/mL as predictors of poor survival. NLR and CA19-9 level were also independent prognostic factors in the group of patients who underwent surgery. CONCLUSIONS High pretreatment NLR, CA19-9 level, and PS are predictors of poor prognosis in patients with metastatic gastric cancer. In selected patients, gastrectomy can be performed safely, and may be associated with longer survival.
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Affiliation(s)
- Yasuhiko Mohri
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Koji Tanaka
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masaki Ohi
- Department of Innovative Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Susumu Saigusa
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hiromi Yasuda
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yuji Toiyama
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Toshimitu Araki
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yasuhiro Inoue
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masato Kusunoki
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
- Department of Innovative Surgery, Mie University Graduate School of Medicine, Tsu, Japan
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Karakas E, Oetzmann von Sochaczewski C, Haist T, Pauthner M, Lorenz D. Grenzen der Chirurgie bei Karzinomen des oberen Intestinaltraktes. Chirurg 2014; 85:186-91. [DOI: 10.1007/s00104-013-2598-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Sun J, Song Y, Wang Z, Chen X, Gao P, Xu Y, Zhou B, Xu H. Clinical significance of palliative gastrectomy on the survival of patients with incurable advanced gastric cancer: a systematic review and meta-analysis. BMC Cancer 2013; 13:577. [PMID: 24304886 PMCID: PMC4235220 DOI: 10.1186/1471-2407-13-577] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 11/28/2013] [Indexed: 12/12/2022] Open
Abstract
Background Palliative gastrectomy for patients with advanced gastric cancer remains controversial. The objective of the present meta-analysis was to analyze survival outcomes and establish a consensus on whether palliative gastrectomy is suitable for patients with incurable advanced gastric cancer and which type of patients should be selected to receive palliative gastrectomy. Methods A literature search was conducted in PubMed, EMBASE and the Cochrane Library. The results for overall survival in the meta-analysis are expressed as hazard ratios (HRs) with 95% confidence intervals (CIs). Results Of 1647 articles and abstracts reviewed, 14 studies with 3003 patients were eligible for the final analysis. The meta-analysis revealed that palliative gastrectomy is associated with a significantly improvement in overall survival (HR 0.56; 95%CI 0.39–0.80; p < 0.002) compared that of patients treated without palliative gastrectomy. An improvement in survival was also observed in patients with stage M1 gastric cancer who received palliative gastrectomy (HR 0.62; 95%CI 0.49–0.78; p < 0.0001), especially those with peritoneal dissemination (HR = 0.76, 95%CI 0.63–0.92), liver metastasis (HR = 0.41, 95%CI 0.30–0.55), or distant lymph-node metastasis (HR = 0.36, 95%CI 0.23–0.59). Combined hepatic resection may be beneficial for patients who under palliative gastrectomy (HR 0.30; 95%CI 0.15–0.61; p = 0.0008). The overall survival of patients who underwent palliative gastrectomy combined with chemotherapy was significantly improved (HR 0.63; 95%CI 0.47–0.84; p = 0.002). Conclusions From the results of the meta-analysis, palliative gastrectomy for patients with incurable advanced gastric cancer may be associated with longer survival, especially for patients with stage M1 gastric cancer. Combined hepatic resection for patients with liver metastasis and chemotherapy may be beneficial factors compared to simple palliative gastrectomy.
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Affiliation(s)
- Jingxu Sun
- Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, Shenyang 110001, China.
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Stenholm L, Stoehlmacher-Williams J, Al-Batran SE, Heussen N, Akin S, Pauligk C, Lehmann S, Senff T, Hofheinz RD, Ehninger G, Kramer M, Goekkurt E. Prognostic role of microRNA polymorphisms in advanced gastric cancer: a translational study of the Arbeitsgemeinschaft Internistische Onkologie (AIO). Ann Oncol 2013; 24:2581-2588. [PMID: 23975664 DOI: 10.1093/annonc/mdt330] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND To determine the prognostic role of selected microRNA (miRNA) polymorphisms in advanced gastric cancer (AGC). PATIENTS AND METHODS Six hundred and seventy-four AGC patients received 5-fluorouracil (F), leucovorin (L), oxaliplatin (O) or FL + cisplatin (P) or additional docetaxel (T) to FLO (FLOT) within four clinical trials. Polymorphisms of mir-26a1 (rs7372209), mir-27a (rs895819), mir-100 (rs1834306), mir-146a (rs2910164), mir-196-a2 (rs11614913), mir-219-1 (rs107822) and mir-423 (rs6505162) were genotyped. Variable selection for the final multivariate model (n = 487) was based on univariate and multivariate Cox-regression analyses with a cut-off P-value of ≤ 20%. RESULTS Genetic factors significantly associated with overall survival (OS) were rs7372209 (mir-26a1) variant genotypes (hazard ratio, HR 1.307 [95% confidence interval (CI) 1.031-1.656], P = 0.0272), rs895819 (mir-27a) variant genotypes (HR 1.304 [95% CI 1.031-1.650], P = 0.0270) and rs11614913 (mir-196a2) variant genotypes (HR 0.791 [95% CI 0.625-1.000], P = 0.0497). Clinical factors with significant impact on OS were Eastern Cooperative Oncology Group (ECOG) 2 performance status (HR 1.880 [95% CI 1.254-2.820], P = 0.0023), curative surgery of advanced disease (HR 0.235 [95% CI 0.123-0.449], P < 0.0001) and addition of docetaxel in locally AGC patients (HR 0.348 [95% CI 0.145-0.838], P = 0.0301). Combined analyses revealed an improved OS in patients without any unfavourable genotype of 18 months compared with 14, 12 and 10 months in patients with 1, 2 and 3 unfavourable genotypes, respectively (P = 0.0257). CONCLUSIONS These data suggest a significant impact of selected miRNA polymorphisms on prognosis in AGC.
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Affiliation(s)
- L Stenholm
- Department of Oncology, Haematology and Stem Cell Transplantation, University Hospital Aachen, RWTH Aachen University, Aachen
| | - J Stoehlmacher-Williams
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, University of Dresden, Dresden
| | - S E Al-Batran
- Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt
| | - N Heussen
- Department of Medical Statistics, RWTH Aachen University, Aachen
| | - S Akin
- Department of Oncology, Haematology and Stem Cell Transplantation, University Hospital Aachen, RWTH Aachen University, Aachen
| | - C Pauligk
- Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt
| | - S Lehmann
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, University of Dresden, Dresden
| | - T Senff
- Department of Oncology, Haematology and Stem Cell Transplantation, University Hospital Aachen, RWTH Aachen University, Aachen
| | - R D Hofheinz
- III Medical Clinic, University Hospital Mannheim, University of Heidelberg, Mannheim
| | - G Ehninger
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, University of Dresden, Dresden
| | - M Kramer
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, University of Dresden, Dresden
| | - E Goekkurt
- Department of Oncology, Haematology and Stem Cell Transplantation, University Hospital Aachen, RWTH Aachen University, Aachen; Haematologisch-Onkologische Praxis Eppendorf, Hamburg, Germany.
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Ridwelski K, Gastinger I, Ptok H, Meyer F, Dralle H, Lippert H. [Surgical treatment of gastric carcinoma. German multicenter observational studies]. Chirurg 2013; 84:46-52. [PMID: 23329311 DOI: 10.1007/s00104-012-2394-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The aim of the review is to compare the results of selected German multicenter observational studies on the surgical treatment of gastric carcinoma within the last two decades. Overall, 6,035 patients with gastric cancer who had been registered in numerous German comprehensive surgical clinics and departments in the time periods 1986-1989, January through December 2002 and 2007-2009 were enrolled in this analysis. In particular, the study aimed to investigate the most important criteria and factors with an impact on the perioperative and early postoperative outcome including the effects on oncological long-term results. In addition to the advances in diagnostic procedures and surgical techniques, the impact of multimodal therapeutic concepts which have been established particularly in the third investigation period is emphasized.
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Survival benefit of palliative gastrectomy in gastric cancer patients with peritoneal metastasis. World J Surg 2013; 36:2637-43. [PMID: 22820871 DOI: 10.1007/s00268-012-1721-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The survival benefit of palliative gastrectomy in patients with peritoneal metastasis as a single incurable factor remains unclear. METHODS A total of 148 gastric cancer patients with peritoneal metastasis underwent gastrectomy or chemotherapy at the Shizuoka Cancer Center between September 2002 and December 2008 and were included in this study. The effects of gastrectomy and chemotherapy on their long-term outcome were investigated. Multivariate analysis was also performed to identify independent prognostic factors. RESULTS Gastrectomy was performed in 82 patients and subsequent chemotherapy was administered to 55. Chemotherapy was selected as an initial treatment for 66 patients. Median survival time (MST) was identical between patients with and without gastrectomy (13.1 vs. 12.0 months; P = 0.410). Conversely, MST was significantly longer in patients who received chemotherapy (13.7 months) than those who did not (7.1 months; P = 0.048). According to the results of multivariate analysis, chemotherapy (hazards ratio [HR] = 0.476; 95 % CI = 0.288-0.787) was selected as an independent prognostic factor, while gastrectomy was not. CONCLUSIONS The results of the present study did not show a survival benefit of palliative gastrectomy in selected patients with peritoneal metastasis. Instead, chemotherapy has to be considered as an initial treatment for these patients.
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